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Remote Optum Utilization Review Jobs in Wisconsin

Pharmacy Careers

Appeals Pharmacist (Remote)

Milwaukee, WI · On-site +1

$56.50 - $68.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Madison, WI · On-site +1

$57.75 - $70.25/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

CSAA

Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

CSAA

Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

CSAA

Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

Wisconsin

AI Innovation Engineer

Madison, WI · On-site +1

$90K - $135K/yr

Assisting in the management of a cloud-based application platform including utilization ... Remote work requires an approved flexible work arrangement (FWA), which is reviewed and approved ...

WPS Health Solutions

Provider Contract Manager

Madison, WI · On-site +1

$85K - $110K/yr

... quality, utilization, and member satisfaction. * Educate providers on policies, tools, and ... Please review Remote Worker FAQs for additional information Benefits * Remote and hybrid work ...

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Remote Optum Utilization Review information

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is a Remote Optum Utilization Review position?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review Nurse, and why are they important?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.
What are popular job titles related to Remote Optum Utilization Review jobs in Wisconsin? For Remote Optum Utilization Review jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Optum Utilization Review jobs in Wisconsin look for? The top searched job categories for Remote Optum Utilization Review jobs in Wisconsin are:
What cities in Wisconsin are hiring for Remote Optum Utilization Review jobs? Cities in Wisconsin with the most Remote Optum Utilization Review job openings:
Remote Optum Utilization Review jobs near you

Utilization Review Specialist-Remote

Wellbrook Recovery

Brookfield, WI • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Job description

Utilization Review Specialist – Behavioral Health Facility

We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.

Responsibilities:

  • Conduct utilization reviews and obtain prior authorizations from insurance companies

  • Monitor continued stay and discharge criteria for clients

  • Communicate effectively with clinical and administrative teams

  • Maintain accurate and up-to-date documentation

  • Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.

Qualifications:

  • Background or experience in social work, counseling, or behavioral health is preferred

  • Experience in utilization review or case management for behavioral health is preferred

  • Strong communication and organization skills

  • Ability to work efficiently in a fast-paced environment

  • Confident, proactive, and dedicated work ethic

Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues

Benefits:

  • 401(k)

  • Dental insurance

  • Flexible schedule

  • Health insurance

  • Life insurance

  • Paid time off

  • Vision insurance

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